Since the Republicans think the Affordable Care Act is worth ruining the country over, it seemed like a good time to learn more about Canada's Health Care and compare them. A lot of people talk about how great it is so I wanted to learn more about it.
Canada:
(one of the highest life expectancy rates and lowest infant mortality rates)
1. Health insurance is administered on a non-profit basis by province. Their records are subject to audits to make sure they remain non-profit
2. All necessary health services are required to be insured. That includes doctors, hospitals, and surgical dentists
3. All insured residents are entitled to the same level of health care even with a pre-existing condition
4. Even if you move to another province or leave the country you are entitle on a temporary basis to care from your home province.
5. All insured residents have reasonable access to health care facilities and all doctors, hospitals, ect.... must be provided reasonable compensation for their services. Special doctors are included.
6. Most provinces include extra coverage such as medication but coverage details vary per province
7. You can buy private insurance through most employers as a supplemental thing for services not covered by the province provided care such as glasses
8. Ambulance services are provided when needed
9. Private clinics cannot provide services covered by the Canadian Health Care Law. Costs are usually covered about 80% by private insurance companies.
10. Funding is provided by taxing individual and corporate income tax. Some provinces also use sales tax and lottery funds as well. The Federal government provides some funds to the provinces.
11. The average cost of health care is cheaper then in the United States to begin with. A $1,200 MRI here is $824 there. According to the Washington Post article below that is because of a significantly reduced cost with the single - payer agency. Apparently, it's expensive to deal with all those private providers.
It appears the real drawback is long wait times for care. Most Canadians like this system but think it's not sustainable so they are in favor of investing more into it. They also want that wait time period reduced. I think the real answer to that one is incentives to become doctors. More doctors means more patients can be seen in a reasonable time. Maybe they can arrange for income tax breaks for doctors so they pay lower taxes. That's just one suggestion but it seems like with all those patients more doctors are the answer. How they draw them will be based on resources.
Citation: http://www.canadian-healthcare.org/
Citation: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/07/01/everything-you-ever-wanted-to-know-about-canadian-health-care-in-one-post/
Affordable Health Care Act:
Keep in mind that not all of it has gone into effect yet so we haven't seen what it will really be like in full. Also, this is the negotiated version. The original version presented in 2010 was a lot more generous to the poor and middle class. Then the Republicans got to it.
1. Children under 19 can't be excluded for pre-existing conditions. It applies to everyone starting in 2014. If you privately bought your plan before March of 2010 you are "Grandfathered" and have to wait until 2014. If you bought your plan after March of 2010 it already applies.
2. If you're 26 or under you are eligible to stay on your parent's health plan even if you are married, not living with your parents, in school, not financially dependent on your parents and are eligible to be covered through an employer
3. Previously, insurers could retroactively cancel your coverage for an honest application mistake made by you or your employer. They could ask you to pay back what they have paid for as well. But not anymore. They can cancel your policy for intentional errors like false or incomplete information on your insurance application and if you fail to pay your premiums on time but not for honest little mistakes. They have to give you a 30 day appeal time before canceling the coverage as well.
4. You can now ask your plan to reconsider it's denial of a payment. The appeal forces them to look at their decision, They have to notify you why your claim was denied and you right to an internal and external appeal (if the internal appeal was unsuccessful).
5. There is no longer a lifetime limit to coverage. Apparently, there used to be a cap to what an insurance company would pay through a person's life for their care.
6. A company cannot raise your rates by more then 10% without giving their reasons for it. Those reasons can be found here:
http://www.HealthCare.gov
A rate review program on that site will tell you if your rate is unreasonable. For some states, a state regulator can approve or not approve of the rate hike. That is also the link for the marketplace to find insurance.
7. 80% for individuals and 85% for groups of 50 or more people; That's the percentage for how many premium dollars have to go to health care needs like doctor visits and medication costs. Anything above that means rebates to the customers (I mean patients). Rebates might include a rate adjustment, a check, or a refund to your debit or credit card.
8. no cost to patient preventative care. A lot is covered so I just included the link but I think they are doing this wrong because I always pay for Zach's flu shot. That's supposed to be covered. We'll see what happens this year http://www.hhs.gov/healthcare/prevention/index.html I'm sure there is a loophole they are using. Last year he got the nose spray vaccine maybe the needle vaccine is what's covered. We'll find out later in the month.
9. You can choose any primary doctor or Pediatrician from your network. I thought that was always the case though.
10. One thing that already kicked in (and has helped us) is a tax refund for high deductible plans. These are connected to a Health Savings Account.
Citation: http://www.treasury.gov/resource-center/faqs/taxes/Pages/Health-Savings-Accounts.aspx
Citation: http://www.hhs.gov/healthcare/rights/index.html
One thing that has been highly publicized is that full time employee rule. Employers with 50 or more employees are required to provide health insurance for all employees working 30 hours or more. Some greedy employers have cut employee hours in response to this but I wonder if the 30 hours rule applies to all companies or those buying plans on the marketplace. I am doing further research on this.
Every state has decided how they want to handle it. You have to look up your state's policy on if they joined the Medicaid expansion. The Federal government will provide some financial assistance for this. By law, everyone has to sign up for some sort of medical coverage by January of 2014 or they will have to pay a tax penalty. But using the link below helps you get the best quote for you so you are shopping for the best insurance. In theory, this will eventually force private insurers to provide better coverage to stay competitive. If that were to happen it's probably many years away.
Edit 10/4/2013: I went to research why I still have to pay $90 a month for my birth control after United Health Care pays their part and here is what I learned. These rules apply to those policies you obtained through the marketplace (link below). Regular insurance companies have more restrictions then before but aren't required to follow all of that by law. In the coming week I will be researching plans on the marketplace to see if there is one that we can afford that better matches our needs. The current plan is through Josh's work. They aren't required to follow all of these rules but they are some. I'll get back to you when I know what parts ALL insurance companies HAVE to follow, not just market place companies.
That's the plan, as more people do what I am doing and search for something more affordable, non-marketplace companies will be forced to change some of their coverage in order to keep customers. In time, that supply and demand should improve coverage but it's not changing the actual costs of medications, tests, and doctor visits.
Only in-network doctors are covered through the market place so part of my research will include calling our doctors to see what market place plans they take. I will also try to find what Zach's asthma medicine would cost us on the different plans and their mental health coverage. I want to figure out what our bills will probably look like under the different plans. Josh reminded me that the money that goes to his health insurance and Health Savings Account isn't taxable now but will be once part of his regular paycheck. I need to find out the tax rate so I know what his paycheck will really look like so I know what we really can afford. It will be a lot of work but it might be worth it.
Sign Up Here Now:
https://www.healthcare.gov/
Personal Opinion:
The biggest problem we have is the actual cost of everything. I have some of my own health issues that I can't see a doctor about because we can't afford to. That's not okay. How did the costs get so out of hand? Back in the Canada section I mentioned that their costs are cheaper because they aren't dealing with all those private insurance companies. That's the American dilemma, having private insurance companies but making things in general cost less. Why is the medication allowed to be so expensive? Why are doctors allowed to charge so much? It will help that insurers are now forced to spend those high percentages of premiums on patient care. Too many of these insurers heavily financed expensive new sports stadiums and arenas while raising cost of premiums and leaving patients with almost impossible high deductibles. That's not okay.
What is a poor person supposed to do when they can't afford their part of the bill even if they are insured? Die of curable injuries and/or diseases. If someone can't afford that $150 for asthma medicine (after insurance has paid their part) they can't take it, at least not as often as they need. They are much more likely to die of an Asthma attack. The rich decision makers don't care because they can afford to pay their bills. They aren't really seeing how the heavy cost of care and medications effect regular people. The economy would be a lot strong if these expenses were a lot more under control.
Which one is better? I can't choose because we haven't experienced the full effect of the Affordable Care Act and won't until 2016. I won't really be able to form an opinion until 2017 when we've lived with it in full for a while. I just can't see what Republicans think is so bad about it that it deserves ruining the country over. Pass the debt and save this debate for a separate bill but the world shouldn't suffer over this. It's not perfect and life will be worse for some people but the majority of Americans will benefit in at least some ways because of it. Those who will suffer most are in states that declined the Medicaid expansion. Below is an article I just read. Some people share their story of how Obamacare has helped them.
http://www.huffingtonpost.com/2013/10/05/i-am-obamacare-_n_4046470.html?utm_hp_ref=healthy-living&ir=Healthy+Living
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